Hepatitis A causes inflammation of the liver which usually resolves with the help of our immune system, however, Hepatitis A can cause serious complications in some people. Hepatitis A may be prevented by vaccination and it is recommended that travelers to most countries outside Canada are vaccinated. Vaccination is particularly important for people traveling rural areas or areas with poor sanitation in developing countries.

• Havrix® is a vaccine to prevent Hepatitis A and is given as two doses at least 6 months apart. The first dose will provide you will short term protection against Hepatitis A and the second dose will provide protection for 20 years or more.
• Twinrix® is a vaccine for Hepatitis A and Hepatitis B and is given as 3 doses. After the first dose is given, the second dose will be given after 1 month and the third after 6 months. The final dose provides protection for 20 years or more.
• It is recommended that you receive 2 doses of Twinrix® before traveling. If you do not have at least 1 month to get the first two doses, you can receive a “fast track” schedule that involves 4 doses whereby the first two injections are given 7 days apart.

Vaccines are the best way to prevent against Hepatitis A, however other general travel recommendations are appropriate. These include:
• Washing hands regularly with soap and water, or, alternatively using hand sanitizer that contains at least 60% alcohol.
• If you are unsure of the safety of the local water supply, drink bottled beverages or water that has been boiled.
• When uncertain of whether food has been washed using clean water, follow the general rule of “boil it, cook it, peel it, or forget it”.
• Avoid salads, raw fruits and vegetables that you haven’t peeled yourself and undercooked foods if food preparation may have been in unsanitary conditions.

Cholera is an infection of the the intestine that is caused by bacteria. This infection can cause severe diarrhea and dehydration. Cholera can be treated with oral rehydration salts and fluids.

• Dukoral® is a drinkable vaccine that is used to decrease your risk of developing cholera. Dukoral® is given as two doses given at least 1 week apart. It is recommended to start Dukoral® at least 3 weeks before traveling to protect you from developing cholera.
• Dukoral® can also help protect you against traveler’s diarrhea caused by E. coli. For protection against traveler’s diarrhea (not cholera) you can take the first dose as late as 2 weeks before traveling and the second dose 1 week before traveling and be protected.
• Dukoral® provides protection against cholera and traveler’s diarrhea for up to 3 months.
• If you have used Dukoral® within the past 5 years, only 1 additional dose is required to provide protection.

• Cholera can be prevented through vaccination and proper food and water hygiene while traveling.
• It is recommended to drink bottled beverages or boiled water if you are unsure of the water sanitation in your area of travel.
• For food, it is recommended to “boil it, cook it, peel it, or forget it”.
• Undercooked foods, salads and raw fruits and vegetables that cannot be peeled should be avoided if there is concern they were not washed with clean drinking water.
• It is important to wash your hands regularly with soap and clean water or use a hand sanitizer with at least 60% alcohol.

Traveler’s diarrhea is the most common illness that develops in people who travel. The risk of developing traveler’s diarrhea is dependent on where you travel, the length of your trip, and the types of food and water you consume.

• The drinkable vaccine Dukoral® can help to prevent traveler’s diarrhea that is caused by E. coli.
• Dukoral® is given as two doses that are taken at least one week apart. You should start Dukoral® at least 2 weeks before you travel and take the second dose at least 1 week before you travel in order to provide appropriate protection against traveler’s diarrhea.
• Dukoral® provides protection against traveler’s diarrhea for up to 3 months.
• If you use Dukoral® again within 5 years, you will only require 1 dose before you travel.

• Food Preparation: “Boil it, cook it, peel it, or forget it”.
• Avoid food from street vendors as well as undercooked foods.
• Avoid foods that have been sitting at room temperature for prolonged periods of time.
• Drink bottled or boiled water if you unsure the water is sanitary.
• Brush your teeth using bottled or boiled water.
• Avoid ice unless it has been prepared from sanitary water.
• Wash hands or use hand sanitizer regularly.

• Prevent dehydration that is caused by diarrhea → drink plenty of water and if moderate or severe diarrhea, use oral rehydration powders to replenish essential electrolytes.

• Examples of oral rehydration powders include Gastrolyte® and Pediatric Electrolyte®

• Antibiotics such as ciprofloxacin or azithromycin are effective in treating traveler’s diarrhea. It can be appropriate to carry an antibiotic with you while you travel so that you can self treat in the case that you develop traveler’s diarrhea.
• Loperamide (Imodium®) is an option to reduce diarrhea however its use is preferably limited to situations where restrooms are not available.

Typhoid is an infection that is caused by bacteria. The risk of developing typhoid exists in many parts of the world including Africa, Asia, and Latin America. In addition, small outbreaks have occurred in Eastern Europe. Health Canada recommends people traveling to South Asia are vaccinated for typhoid. The risk of developing typhoid increases with the length of your travels and in areas with poor sanitation. The vaccine for typhoid may also be considered for people who travel regularly, are traveling to developing countries, or are traveling for extended periods of time.

• There is a vaccine in the form of oral capsules (Vivotif®). One capsule is taken every second day for 4 doses.
• Injections for typhoid are given as a single injection and the available vaccines are Typherix®, Typhim®, or Vivaxim®.
• The Vivotif® capsules provide protection for 5 to 7 years and the Typherix®, Typhim®, or Vivaxim® injections provide protection for about 3 years.

• Typhoid is transmitted through food and water contaminated with Salmonella typhi bacteria. Therefore, it is important to follow food and water recommendations when you travel.
• It is recommended to drink bottled beverages or boiled water if you are unsure of the water sanitation in your area of travel.
• For food, it is recommended to “boil it, cook it, peel it, or forget it”.
• Undercooked foods, salads and raw fruits and vegetables that cannot be peeled should be avoided if there is concern they were not washed with clean drinking water.
• It is important to wash your hands regularly with soap and clean water or use a hand sanitizer with at least 60% alcohol.